UPDATE 1-U.S. surgeon general calls for end of tobacco epidemic

(Reuters) - Another 5.6 million American children may die
prematurely unless smoking rates fall in the United States,
according to a report by the U.S. surgeon general which links a
range of new illnesses to the habit.

Fifty years after the first surgeon general's report
declared smoking a hazard to human health, the new study adds
conditions ranging from colon cancer to diabetes and arthritis
to the tally of tobacco-related diseases.

The report, the first in more than a decade, found that
smoking has killed more than 20 million Americans prematurely in
the last half century.

Although adult smoking rates have fallen to the current 18
percent from 43 percent of Americans in 1965, each day, more
than 3,200 youths under the age 18 try their first cigarette,
according to the report published on Friday.

"Enough is enough," acting Surgeon General Dr. Boris
Lushniak said in a telephone interview. "We need to eliminate
the use of cigarettes and create a tobacco-free generation."

Federal health officials are calling on businesses, state
and local governments, and society as a whole, to end smoking
within a generation through hard-hitting media campaigns,
smoke-free air policies, tobacco taxes, unhindered access to
cessation treatment and more spending by state and local
governments on tobacco control.

"It's not just the federal lead on this anymore," said
Lushniak. "To get this done, we have to go to industry. We have
to go to healthcare providers and remind them that this problem
is not yet solved."

The report, dubbed The Health Consequences of Smoking, 50
Years of Progress, details the growing science showing the
diseases and health conditions caused by smoking since Dr Luther
Terry issued the landmark report on January 11, 1964, that first
confirmed smoking tobacco caused lung cancer.

In that first report, only lung cancer was associated with
smoking. Now there are 13.

"We're still a country very much addicted to tobacco," U.S.
Health and Human Services Secretary Kathleen Sebelius said at a
White House event to mark the anniversary.

The new report adds liver and colorectal cancer to that
list, but it also details several other conditions caused by
smoking, including diabetes, rheumatoid arthritis and impaired
immune function, and cleft palate in infants.

And in a startling statistic, the report found that exposure
to secondhand smoke increases the risk of stroke by 20 to 30
percent.

"It really is astonishing that even 50 years in, we are
finding new ways that tobacco maims and kills people," Dr.
Thomas Frieden, director of the U.S. Centers for Disease Control
and Prevention, said in a telephone interview.

He said the report found that smoking costs the nation $130
billion in direct medical expenses each year.

Frieden reiterated that tobacco control efforts have saved
as many as 8 million lives in the past five decades, but
stressed that much more needs to be done to eliminate smoking,
which remains the leading cause of preventable death in the
United States.

At the White House, officials pointed squarely at the
tobacco industry continued efforts to promote their products.

"This is not an accident," Assistant Health Secretary Howard
Koh said. "These deaths do not occur just by chance. Each year,
the tobacco industry spends $8 billion - nearly $1 million an
hour - to advertise and market cigarettes and smokeless tobacco
products."

As a result, Lushniak urged public health officials to take
tougher action to curb tobacco use: "It's all about getting more
aggressive than we have been."

Officials called on states to increase their investment in
smoking prevention.

CDC's Frieden said states get $80 per capita from tobacco
companies related to a major legal settlement in 1998, in which
big tobacco makers agreed to pay $206 billion to 46 states to
help pay the costs of treating ailing smokers.

Although CDC recommends that states spend at least $12 per
person on tobacco control, states "actually only spend about
$1.50, and it's been decreasing in recent years," he said.

Harold Wimmer, president and chief executive of the American
Lung Association, said the new report, coming on the heels of
the 50th anniversary of the landmark 1964 report, present an
opportunity for renewed political commitment to ending the
tobacco epidemic.

On Wednesday, his group will release its own report grading
state and federal efforts to control tobacco.

"Only a recommitment to a heightened level of action will
enable us to finish the job," Wimmer said.

Last week, the group and other advocacy organizations called
on political leaders to commit to cutting smoking rates to less
than 10 percent of the population in a decade and to protect all
Americans from secondhand smoke within five years.

Friday's report briefly touched on the increasingly
controversial topic of electronic or e-cigarettes - devices
designed to deliver nicotine through vapor instead of tobacco
smoke. It noted that major tobacco companies, including Altria
Group Inc, best known for its Marlboro brand; Reynolds American
Inc, maker of Camel cigarettes; and Lorillard Inc, maker of
Newport cigarettes, have invested in the products.

Previous studies have suggested that people can use the
devices as smoking cessation tools, but some public health
advocates worry that e-cigarettes might introduce more people to
nicotine, the addicting chemical found in tobacco. Electronic
devices that feature fruit and candy flavors are even more
worrying, critics say, because they could introduce children to
smoking.

And there are still questions about the safety of the vapors
released by the devices. Health groups and state attorneys
general have been pressuring the FDA to impose regulations on
the devices.

CDC's Frieden urged caution as the industry comes up with
various new products given the known dangers about tobacco.

"If we're talking about tobacco products ... they are guilty
until proven innocent, not the other way around," he said at the
White House. "All of these products may have an positive role is
appropriately regulated but not in the way that they are being
sold now with widespread marketing, over the Internet, with
bubble gum and cotton candy flavors, with free samples."

Altria said in a statement that it supports the FDA's
authority to regulate e-cigarettes as an extension of its power
to regulate tobacco.

"Our tobacco companies continue to focus on developing
lower-risk products that appeal to adult tobacco consumers and
see this as an important business opportunity under FDA
regulation," the company added.